1. THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute

2. THE URBAN INSTITUTE 2 Outline of the Presentation Overview of Legislation Data and Methods Findings: – Insurance coverage – Access to health care – Affordability of health care – Support for health reform – The remaining uninsured Limitations

3. THE URBAN INSTITUTE 3 Massachusetts Health Reform Legislation passed in April 2006 Many parts, including: – Medicaid (MassHealth) expansions – CommCare--new program that provides income- related subsidies for private coverage – Commonwealth Choice-new purchasing arrangement – More restrictions on care under the safety net – Insurance market reforms – Requirements for employers – Individual mandate

4. THE URBAN INSTITUTE 4 Timeline for implementation MassHealth expansion July 2006 CommCare to adults <100% FPL in October 2006 CommCare to adults <300% FPL in January 2007 Commonwealth Choice in May 2007 Individual mandate with small penalty in 2008 (based on coverage December 31, 2007), larger penalty goes into effect in 2009 Minimum creditable coverage enforced in 2009

5. THE URBAN INSTITUTE 5 Data and Methods Data: Massachusetts Health Reform Survey – Fielded in Fall 2006, Fall 2007 & Fall 2008 (planned) – Telephone interviews with sample of adults 18 to 64 – Sample sizes ~3000 in each year Methods: Estimate impact of health reform as changes over time using a “pre-post” comparison – IMPACT = Fall 2007 – Fall 2006

6. THE URBAN INSTITUTE 6  Uninsurance for working-age adults reduced by almost half in Massachusetts Impact on insurance coverage

7. THE URBAN INSTITUTE 7  Drop in uninsurance larger for low-income adults Impact on insurance coverage

8. THE URBAN INSTITUTE 8  No evidence of crowd-out of ESI for low-income adults Impact on insurance coverage

9. THE URBAN INSTITUTE 9  Low-income adults more likely to have a regular health care provider and to have had health care visits over the prior year Impact on access to care

10. THE URBAN INSTITUTE 10  Both low-income and higher-income adults less likely to have any unmet need for health care over the prior year Impact on access to care

11. THE URBAN INSTITUTE 11  Both low-income and higher-income adults less likely to have unmet need for health care over the prior year because of cost of care Impact on affordability of care

12. THE URBAN INSTITUTE 12  Drop in out-of-pocket health care costs over the prior year for low-income adults Impact on affordability of care

13. THE URBAN INSTITUTE 13  Drop in problems paying medical bills and medical debt over the prior year for low-income adults Impact on affordability of care

14. THE URBAN INSTITUTE 14  Most working-age adults in Massachusetts support health reform Support for health reform

15. THE URBAN INSTITUTE 15  Support for health reform remained high across both low- income and higher-income adults Support for health reform

16. THE URBAN INSTITUTE 16  However, support was lower among adults who remained uninsured in Fall 2007 Support for health reform

17. THE URBAN INSTITUTE 17 The remaining uninsured may be difficult to convince to obtain coverage – Many are young, male, healthy, and low-income – Most are working (68%), but few have access to ESI (11%) – Most reported cost of coverage as reason not insured – Sizable minority (32%) reported they were not aware of individual mandate in Fall 2007 Expanding insurance coverage

18. THE URBAN INSTITUTE 18 Study Limitations One set of estimates of the impacts of reform – Will be important to compare to other surveys as data become available Estimates are of early impacts of reform – Another round of the survey will be fielded in Fall 2008 “Pre-post” evaluation design – Additional studies are being conducted using other data sources and methods

19. THE URBAN INSTITUTE 19 Summary: Early Impacts of Health Reform in Massachusetts Uninsurance among working-age adults reduced by almost half Access to care has improved – More likely to have usual source of care – More likely to have health care visits – Less likely to have unmet need for care Health care is more affordable – Out-of-pocket health care costs are down – Problems paying medical bills and medical debt are down Support for health reform among Massachusetts residents remains high